New Sentara Health Plans Features in Availity

Beginning September 21, 2026, providers can use the authorization capabilities in Availity Essentials™. This includes the ability to:

  • Determine whether an authorization is required within the Availity Request workflow
  • Submit Medical Inpatient and Outpatient authorization requests
  • If prompted, complete clinical criteria through MCG and return seamlessly to Availity Essentials to finish your authorization request
  • Submit authorization attachments
  • Check the status of your authorizations, including authorizations submitted outside Availity Essentials

Availity Learning Center

To access Availity Essentials Authorization training webinars specifically developed for Sentara Health Plans:

Log into Availity Essentials, select Help and Training > Get Trained from the top menu bar. It will bring you to the Availity Learning Center. On the Catalog page, use the search field to type in "Sentara" and press Enter. From there, you can chose webinars you want to enroll in.

Additional Authorization Resources

Availity Provider Portal FAQs

Effective September 21, 2026, Sentara Health Plans is expanding its capabilities in Availity Essentials™ with a full suite of authorization tools. The initial expansion will be available for Medical Inpatient and Outpatient Authorizations for all lines of business (Commercial, Medicaid, and DSNP). We are working to expand these capabilities to Behavioral Health Authorizations soon and we will communicate once they are available.

Until further notice providers should select Sentara Health Plans to submit Authorizations for Medical authorizations (IP and OP). We are in the process of expanding these capabilities to Behavioral Health authorizations (IP and OP) and will communicate once these are available. 

Within the Authorization Request workflow a provider will be prompted to provide the information to determine if an Authorization is required. A response will be returned indicating “No Auth Required;” “Auth Required;” or “See Notes.” Based on the response, the provider will have one of the following paths forward:

  • “No Auth Required” = Hard Stop
  • “Undetermined” = Hard Stop, with a message letting the provider know it is a delegated service and where to go to submit the auth
  • “Auth Required” = provider will proceed with entering the rest of the required information

Providers can also still consult the Prior Authorization Look-up (PAL) Tool and enter the requested information to determine if an Authorization is required.

No. Authorizations issued by our UM delegates will continue to be housed in their internal systems. Providers can access our UM delegate vendor’s portal for authorization requests and status from our Availity Payer Space Application tab. Delegated vendors include: 

  • Evolent - Prior authorization for imaging services
  • Oncohealth - Prior authorizations for Oncology only (chemotherapy, radiation, genetic testing)
  • Avalon - Prior authorizations for non-oncology genetic testing
  • Surescripts - Prior authorizations for Pharmacy
MCG (formerly Milliman Care Guidelines), is evidenced based clinical guidelines used by hospitals, health plans and government agencies to determine medical necessity and the level of care for requested services.
If the MCG prompt appears, you should go to MCG to select the applicable clinical care guidelines for the services being requested. Completing the MCG criteria will facilitate the processing of the Authorization for faster turnaround times. Not all services require an MCG Review, and an MCG prompt may not appear; you can continue to submit your request through Availity.
There is a selection for “No Guideline Applies” that will allow a free text box for providers to manually enter the clinical necessity of the services being requested.
All required attachments should be submitted in Availity. If attachments are submitted in MCG, you will be prompted to submit attachments again in Availity. To avoid duplication, only submit attachments in Availity.
You will be taken back to the Availity portal to complete the authorization process by attaching clinical and submitting for review.
  • Standard: 7 days (Medicaid and DSNP) 15 days (Commercial)
  • Expedited: 72 hours

An Expedited Request is a request for medical care or services where application of the timeframe for making standard, non-urgent or non-life-threatening care determinations could:

  1. Seriously jeopardize the life or health of the member or the member’s ability to regain maximum function, based on a prudent layperson’s judgment
  2. Seriously jeopardize the life, health or safety of the member or others, due to the member’s psychological state
  3. In the opinion of a practitioner with knowledge of the member’s medical or behavioral condition, the member would be subject to adverse health consequences without the care or treatment that is the subject of the request
  • Procedure Codes are required for all Medical Outpatient Authorization requests.
  • Procedure Codes are only required on the Medical Inpatient request when the 2-Surgical Service Type is selected.

Revenue codes are also required for Commercial Skilled Nursing and Therapy Outpatient Home Health Authorizations. However, during this initial phase providers will not be able to submit Commercial Skilled Nursing and Therapy Home Health Authorizations. We are making future adjustments to allow revenue codes for these Authorizations and we will communicate once they are available.

We advise that the provider selects a provider if one is returned in the search to avoid any errors. However, in the limited instances that both the Requesting and Servicing providers are not returned because we don't have a match for them in our system, the submitter will be prompted to do a manual entry.
Yes, providers can obtain Authorization status in Availity's Inquiry feature regardless of how the Authorization was submitted. For example, if the Authorization Request was faxed in or submitted via the JIVA portal they will still be able to obtain the status via Availity.
No. These letters will continue to be sent via fax or mail as they do today. Providers can obtain the status of the Authorization on Availity using either the Dashboard or Inquiry features and use the Print option at the top of the page to print a copy of the decision.
No. Until Sentara can offer this capability, you can enter the initial request and submit attachments within the initial submission via Availity, but once the Authorization is submitted providers will need to fax any additional information. When submitting the fax please include the Authorization# and Member ID, Member Name, Member DOB. To avoid processing delays, use the fax number for the appropriate requested service and member plan. These fax numbers can be found on the top of the fax request forms found here: Authorizations | Providers | Sentara Health Plans
Availity is a multi-payer portal where providers can check eligibility and benefits, manage claims, request service authorizations and more to streamline their work. Many of you are already using Availity with other payers that you are contracted with and are familiar with its ease of use.
If you are already working in the Availity Essentials portal, the same user ID and password can be used to sign in to the Essentials account for Sentara Health Plans. For a refresher, please visit Availity’s Reference Guide for Admins and Reference Guide for Users. Please note that we are in the process of a transition so not all features are available for Sentara Health Plans yet.
For providers new to Availity Essentials, the Get Started page has an abundance of resources, and a link to register. Once an Availity Essentials account has been created, navigate to the “Help and Training” button in the upper right corner of the home screen, then select “Get Trained” for additional training options.
You should call the Availity Customer Support Team at 1-800-282-4548. They can assist with troubleshooting and will work directly with Sentara to resolve issues and get back to you regarding the resolution.   

To access applications in Availity Essentials, you will need specific role(s) assigned to your user accounts. For the features currently available in Availity Essentials you will need the following roles:

  • Eligibility and Benefits role to access the Eligibility & Benefits application.
  • Claim role to access the Claim application.
  • Claim Status role to access Remittance Viewer. 
  • Authorization and Referrals Request 
  • Authorization and Referrals Inquiry
The Availity Administrator in your organization assigns roles and permissions. If you are missing a role or do not have access to one of the applications, reach out to the Availity administrator within your organization.

You can locate the organization’s Availity Administrator by navigating to [Your Name's] Account at the top of the Availity Essentials home page. Select My Account | Organization(s) | Open My Administrators.

Provider Support